Femur Anatomy and Attachments

By

 Arun Pal Singh 

The femur is also called the thigh bone and is the longest and strongest bone of the body. It is composed of upper end, lower end and a shaft.
The upper and bears a rounded head, whereas the lower end is widely expanded to from two large condyles. The head is directed medially. The cylindrical shaft is convex forwards.

Upper end of Femur

The upper end of the femur includes the head, the neck, the greater trochanter, the lesser trochanter, the intertrochanteric line, and the intertrochanteric crest.

Head of Femur

Head articulates with acetabulum to form a hip joint. It is more than half a sphere, and is directed medially, upwards and slightly forwards.
Fovea is a roughened pit just below and behind the center of the head. Head, in its most part is covered by cartilage.

Neck of Femur

Neck is about is about 3-3.5 cms long and connects head with shaft. The neck forms an angle with shaft, known as neck shaft angle and is about 125 in adults [lesser in females]. The angle facilitates movements of the hip joint. Femoral neck is strengthened by a thickening of bone called the calcar femorale present along its concavity.
The neck has two borders and two surfaces
The upper border, concave and horizontal, meets the shaft at the greater trochanter. The lower border, straight and oblique, meets the shaft near the lesser trochanter.
The anterior surface is flat and meets the shaft at the interochanteric line. Anterior surface of femoral neck is entirely interacapsular. Upper part of this surface may be covered by articular cartilage.
The posterior surface is convex from above downwards and concave from side to side. It meets the shaft at the intertrochanteric crest. It is not intracapsular in its lower lateral part.
Antecersion is the angle formed between the transverse axis of the upper and lower ends of the femur. It is about 15 degrees.
Read more about anteversion

Greater Trochanter

Greater trochanter is a large quadrangular prominence located at the upper part of the junction of the neck with shaft. The upper border of the trochanter lies at the level of the center of the head.
The greater trochanter has an upper border with an apex, and 3 surfaces (anterior, medial and lateral). The apex is the inturned posterior part of the posterior border. The anterior surface is rough in its lateral part. The medial surface presents a rough impression, above and a deep trochanteric fossa, below. The lateral surface is crossed by an oblique ridge directed downwards and forwards.

Lesser Trochanter

It is a conical eminence directed medially and backwards from the junction of the posterior part of the neck with the shaft.

Intertrochanteric Line

It marks the junction of neck with the femur. It is a roughened ridge from anterosuperior angle of the greater trochanter (as a tubercle), and is continuous below with the spiral line in front of the lesser trochanter.
Spiral line is a curved line with its superior end adjacent to the lesser trochanter, nearly continuous with the intertrochanteric line, and converging inferiorly with the pectineal line to form the medial lip of the linea aspera.
It forms the medial boundary of the distal attachment of the iliacus muscle.The spiral line winds round the shaft below the lesser trochanter to reach the posterior surface of the shaft.

Intertrochanteric Crest

It marks the junction of the posterior surface of the neck with the shaft of the femur. It   is smooth rounded ridge which begins above at the posterior superior angle of the greater trochanter and ends at the lesser trochanter. The rounded elevation, a little above its middle is called the quadrate tubercle.

Shaft of Femur

The shaft is almost a cylindrical structure wide superiorly and inferiorly and narrowest in the middle. It is convex forwards and is directed obliquely downwards and medially.

Credit:Teach Me Anatomy

The shaft in middle one-third has three borders -medial, lateral and posterior. The medial and lateral borders are rounded and ill- defined, but the posterior border is in the form of a broad roughened ridge, called the linea aspera. Linea aspera is an important landmark in orthopedics surgeries involving reduction of femoral fractures.
The Linea aspera has distinct medial and lateral lips. The medial and lateral surfaces are directed more backwards than to sides.
The shaft possesses 3 surfaces as well – anterior, medial and lateral.
In upper on third of the shaft he two lips of the Linea aspera diverge wide to form an additional posterior surface and four borders (medial, lateral, spiral line and the lateral hip of the gluteal tuberosity) and 4 surfaces (anterior, medial, lateral and posterior).
The gluteal tuberosity is a broad roughened ridge on the lateral part of the posterior surface.
Similarly, the  two lips of the Linea aspera diverge in lower one third and enclose an additional, popliteal surface. Thus this part of the shaft has four border (medial, lateral, supracondylar line and lateral supracondylar line) 4 surfaces (anterior, medial, lateral and popliteal). The medial border and medial supracondylar line meet inferiorly to obliterate the medial surface.

Lower End of Femur

The lower end of the femur is wide and expanded. It has two large condyles –  medial and lateral. Anteriorly, the two condyles are united and are in a line with the front of the shaft. Posteriorly, they are separated by a deep gap, termed the interocondylar fossa or intercondylar notch, and project backwards much beyond the plane of the popliteal surface.

Credit:Teach Me Anatomy

Credit:Teach Me Anatomy

The lateral condyle is flat laterally, less prominent than medial condyle and stouter than it. It has a prominence  called the lateral epicondyle. Below it lies the popliteal groove with deeper anterior part and a shallower posterior part.
Medial condyle is  convex medially. It also bears a prominent point called the medial epicondyle. Adductor tubercle is a projection posterosuperior to the epicondyle which serves as an important landmark.  The epiphyseal line for the lower end of the femur passes through it.
Interondylar fossa or notch separates the lower and posterior parts of the two condyles. Intercondylar line separates notch from the popliteal surface. Anteriorly, the notch is limited by patellar articular surface.
The two condyles are partially covered by a large articular surface. Anteriorly, the condyles articulate with patella and this articualtion extends more on the lateral condyle than on the medial.Between the two condyles, the surface is grooved vertically.  Two faint grooves separate the patellar articualtion surface from tibial surfaces. Tibial articulation surface over the  lateral condyle is short and straight anteroposteriorly whereas the part over the medial condyle is longer and is convex medially.

Attachments on the Femur

Head of Femur

The fovea on the head of the femur provides attachment to the ligament of the head (round ligament, or ligamentum teres).

Greater Trochanter

• The piriformis is inserted into the apex
• The gluteus minimus is inserted into the rough lateral part of the anterior surface
• The obturator internus and the two gemelli are inserted into the upper rough impression on the medial surface
• The obturator externus is inserted into the trochanteric fossa
• The gluteus medius is inserted into the ridge on the lateral surface.
• The trochanteric bursa of the gluteus medius lies in front of the ridge, and the trochanteric bursa of the gluteus maximus lies behind the ridge.

Lesser Trochanter

• The psoas major is inserted on the apex and medial part of the rough anterior surface.
• The iliacus is inserted on the anterior surface of the base of the trochanter, and on the area below.
• Gluteus minimus bursa lies deep to the upper horizontal fibrres of the adductor magnus.

Intertrochanteric Line

Following structures attach to intertrochanteric line

• Capsular ligament of the hip joint
• Iliofemoral ligament in its upper part
• Lower band of the iliofemoral ligament in its lower part
• Highest fibres of the vastus lateralis from the upper end
• Highest fibres of the vastus medialis from the lower end
• Quadratus femoris attached on quadrate tubercle

Shaft of Femur

• The medial and popliteal surfaces are bare [ Except for part of gastrocnemius origin on the popliteal surface]
• Vastus intermedius – upper three fourths of the anterior and lateral surfaces.
• Articularis genu – just below the vastus intermedius.
• Vastus lateralis –  upper part of the intertrochanteric line, anterior and inferior borders of the greater trochanter, the lateral lip of the gluteal tuberosity, and the upper half of the lateral lip of the line aspera.
• Vastus medialis – Lower part of the intertrochanteric line, the spiral line, the medial lip of the linea aspera, and the upper one –fourth of the medial supracondylar line.
• Gluteal tubersosity receives insertion of deeper fibres of the lower half of the gluteus maximus
• Adductor longus  – Medial lip of the linea aspera between the vastus medialis and the adductor brevis and magnus
• Adductor brevis is inserted into a line extending from the lesser trochanter to the upper part of the linea aspera, behind the pectineus and the upper part of the adductor longus.
• Adductor magnus is inserted into the medial margin of the gluteal tuberosity, the linea aspera, the medial superacondylar line, and the adductor tubercle
• Pectineus is inserted on a line extending from the lesser trochanter to the linea aspera.
• Short head of the biceps femoris arises from the lateral lip of the linea aspera between the vastus lateralis and the adductor magnus, and from the upper two – thirds of the lateral superacondylar line
• Medial and lateral intermuscular septa are attached to the lips of the linea aspera and to the supracondylar line. These septae  separate the extensor muscles from the adductor medially, and from the flexors laterally.  The lower end of the lateral supracondylar line gives origin to the plantaris above and the upper part of the lateral head of the gastrocnemius below.
•  The popliteal surface is covered with fat and forms the floor of the popliteal fossa. Medial head of the gastrocnemius extends to the popliteal surface just above the medial condyle.

Lateral Condyle

• Fibular collateral ligament of the knee attaches to the lateral epicondyle.
• The popliteus aries from the deep anterior part of the popliteal groove. When the knee is flexed the tendon of this muscle lies in the shallow posterior part of the grove.
• The muscular impression near the lateral epicondyle gives origin to the lateral head of the gastrocnemius.

Medial Condyle

• Tibial collateral ligament of the knee – medial epicondyle
• Hamstring part of the adductor magnus – adductor tubercle

Intercondylar Notch

• Anterior cruciate ligament – posterior part of the medial surface of the lateral condyle.
• The intercondylar line provides attachment to the capsular ligament and laterally to the oblique popliteal ligamemt.
• The infrapatellar synovial fold is attached to the anterior border of the intercondylar fossa.

Following video summarizes the femoral bone

Ossification of Femur

One primary and four secondary centres.

The primary centre for the shaft appears in the 7 week of intrauterine life.
The secondary centres appear as follows

• Lower end of Femur – At end of the 9th month of intrauterine life
• Head –  first six months of life
• Greater trochanter – 4 years
• Lesser trochanter  – 12 years

The upper apiphyses (lesser trochanter, greater trouchanter and head, in that order) fuse with the shaft at about 18 year. The lower epiphysis fuses by the 20th year.

Blood supply of Femur

• The smaller, medial part of the head, near the fovea, is supplied by medial epiphyseal arteries derived from the posterior division of the obturator artery and from the ascending branch of the medial circumflex femoral artery. These arterial twigs enter the acetabular notch and then pass along the round ligament to reach the head.
• The larger, lateral part of the head is supplied by lateral epiphyseal arteries which are derived from the retinacular branches of the medial circumflex femoral artery. This set constitutes the main supply and damage to it results in necrosis of the head of the following fractures of the neck of the femur. After epiphyseal fusion, the lateral epiphyseal arteries anastomose freely with the metaphyseal arteries.
• The intracapsular neck is supplied by the retinacular arteries derived chiefly from the trochanteric anastomosis. The vessels produce longitudinal grooves and formina directed towards the head, mainly on the anterior and posterior- superior surface. The extracapsular part of the neck is supplied by the ascending branch of the medial circumflex femoral artery.
• Nutrient artery to shaft of femur is  derived from the second perforating arteryThe nutrient foramen (or foramina) is located on the medial side on the linea aspera, and is directed upwards.
• Lower end is supplied by genicular arteries and anastomosis around the knee

Significance of Femur

• Femur is a common bone to be injured
• Ossification of the lower end of the femur is of medicolegal importance. Presence of its centre in a newly born child found dead indicates that the child was  capable of independent existence.
• Coxa valga is a condition where the femoral neck shaft angle is more than normal. ( 135 degrees)
• Coxa vara is a condition where the neck shaft angle is less than normal (120 degrees)

What is a cast?

A cast holds a broken bone in place as it heals. Casts also help to prevent or decrease muscle contractions, and are effective at providing immobilization, especially after surgery.
Casts immobilize the joint above and the joint below the area that is to be kept straight and without motion. For example, a child with a forearm fracture will have a long arm cast to immobilize the wrist and elbow joints.

What are casts made of?

The outside, or hard part of the cast, is made from two different kinds of casting materials.

• Plaster (white in color)
  
• Fiberglass (comes in a variety of colors, patterns, and designs)
  

Cotton and other synthetic materials are used to line the inside of the cast to make it soft and to provide padding around bony areas, such as the wrist or elbow.
Special waterproof cast liners may be used under a fiberglass cast, allowing the child to get the cast wet. Consult your child's doctor for special cast care instructions for this type of cast.

What are the different types of casts?

Below is a description of the various types of casts, the location of the body they are applied, and their general function.

Type of cast	Location	Uses
Short arm cast	Applied below the elbow to the hand.	Forearm or wrist fractures. Also used to hold the forearm or wrist muscles and tendons in place after surgery.
Long arm cast	Applied from the upper arm to the hand.	Upper arm, elbow, or forearm fractures. Also used to hold the arm or elbow muscles and tendons in place after surgery.
Arm cylinder cast	Applied from the upper arm to the wrist.	To hold the elbow muscles and tendons in place after a dislocation or surgery.

Click Image to Enlarge

Type of cast	Location	Uses
Shoulder spica cast	Applied around the trunk of the body to the shoulder, arm, and hand.	Shoulder dislocations or after surgery on the shoulder area.
Minerva cast	Applied around the neck and trunk of the body.	After surgery on the neck or upper back area.
Short leg cast	Applied to the area below the knee to the foot.	Lower leg fractures, severe ankle sprains/strains, or fractures. Also used to hold the leg or foot muscles and tendons in place after surgery to allow healing.
Leg cylinder cast	Applied from the upper thigh to the ankle.	Knee, or lower leg fractures, knee dislocations, or after surgery on the leg or knee area.

Click Image to Enlarge

Type of cast	Location	Uses
Unilateral hip spica cast	Applied from the chest to the foot on one leg.	Thigh fractures. Also used to hold the hip or thigh muscles and tendons in place after surgery to allow healing.
One and one-half hip spica cast	Applied from the chest to the foot on one leg to the knee of the other leg. A bar is placed between both legs to keep the hips and legs immobilized.	Thigh fracture. Also used to hold the hip or thigh muscles and tendons in place after surgery to allow healing.
Bilateral long leg hip spica cast	Applied from the chest to the feet. A bar is placed between both legs to keep the hips and legs immobilized.	Pelvis, hip, or thigh fractures. Also used to hold the hip or thigh muscles and tendons in place after surgery to allow healing.

Click Image to Enlarge

Type of cast	Location	Uses
Short leg hip spica cast	Applied from the chest to the thighs or knees.	To hold the hip muscles and tendons in place after surgery to allow healing.

Click Image to Enlarge

Type of cast	Location	Uses
Abduction boot cast	Applied from the upper thighs to the feet. A bar is placed between both legs to keep the hips and legs immobilized.	To hold the hip muscles and tendons in place after surgery to allow healing.

Click Image to Enlarge

How can my child move around while in a cast?

Assistive devices for children with casts include:

• Crutches
  
• Walkers
  
• Wagons
  
• Wheelchairs
  
• Reclining wheelchairs
  

Cast care instructions

• Keep the cast clean and dry.
  
• Check for cracks or breaks in the cast.
  
• Rough edges can be padded to protect the skin from scratches.
  
• Do not scratch the skin under the cast by inserting objects inside the cast.
  
• Can use a hairdryer placed on a cool setting to blow air under the cast and cool down the hot, itchy skin. Never blow warm or hot air into the cast.
  
• Do not put powders or lotion inside the cast.
  
• Cover the cast while your child is eating to prevent food spills and crumbs from entering the cast.
  
• Prevent small toys or objects from being put inside the cast.
  
• Elevate the cast above the level of the heart to decrease swelling.
  
• Encourage your child to move his or her fingers or toes to promote circulation.
  
• Do not use the abduction bar on the cast to lift or carry the child.
  

Older children with body casts may need to use a bedpan or urinal in order to go to the bathroom. Tips to keep body casts clean and dry and prevent skin irritation around the genital area include the following:

• Use a diaper or sanitary napkin around the genital area to prevent leakage or splashing of urine.
  
• Place toilet paper inside the bedpan to prevent urine from splashing onto the cast or bed.
  
• Keep the genital area as clean and dry as possible to prevent skin irritation.
  

When to call your child's doctor

Contact your child's doctor or health care provider if your child develops one or more of the following symptoms:

• Fever greater than 101° F (38.3° C)
  
• Increased pain
  
• Increased swelling above or below the cast
  
• Complaints of numbness or tingling
  
• Drainage or foul odor from the cast
  
• Cool or cold fingers or toes
  

Changes in lumbar multifidus muscle function and nociceptive sensitivity in low back pain patient responders versus non-responders after dry needling treatment.

Abstract

BACKGROUND:

Little is known about the physiologic mechanism of dry needling. While some evidence suggests that dry needling may decrease nocioceptive sensitivity and facilitate muscle function, no studies to date have examined these physiologic changes compared to clinical outcomes.

OBJECTIVE:

To examine changes in lumbar multifidus (LM) muscle function and nociceptive sensitivity after dry needling in patients with LBP and to determine if such changes differ in patients that exhibit improved disability (responders) and those that do not (non-responders).

DESIGN:

Quasi-experimental study.

METHODS:

Sixty-six volunteers with mechanical LBP (38 men, age = 41.3 ± 9.2 years) completed the study. Ultrasound measurements and pain algometry of the LM were taken at baseline and repeated immediately following dry needling treatment to the LM muscles and after one week. The percent change in muscle thickness from rest to contraction was calculated for each time point to represent muscle function. Pressure pain threshold (PPT) was used to measure nociceptive sensitivity. Participants were dichotomized as responders and non-responders based on whether or not they experienced clinical improvement using the modified Oswestry Disability Index after one week. 2 × 3 mixed-model ANOVA were conducted for group (responders vs. non-responders) by time.

RESULTS:

Patient responders exhibited larger improvements in LM muscle contraction and nociceptive sensitivity 1 week, but not immediately, after dry needling than non-responders.

CONCLUSIONS:

Our results suggest that there may be lasting and clinically relevant sensorimotor changes that occur in LBP patients that improve with dry needling treatment that partially explain the physiologic mechanism of action.
Published by Elsevier Ltd.

Not much is known about the physiologic mechanism of dry needling. Although some evidence suggests that dry needling may decrease nocioceptive sensitivity and facilitate muscle function, no studies to date have examined these physiologic changes compared to clinical outcomes. The objective of this study was to examine changes in lumbar multifidus (LM) muscle function and nociceptive sensitivity after dry needling in patients with LBP and to determine if such changes vary in patients that exhibit improved disability (responders) and those that do not (non-responders). Patient responders showed greater improvements in LM muscle contraction and nociceptive sensitivity 1 week, but not immediately, after dry needling than non-responders.
These results indicate that there may be lasting and clinically relevant sensorimotor changes that occur in LBP patients that improve with dry needling treatment that partially account for the physiologic mechanism of action.
- See more at: http://www.physiospot.com/research/changes-in-lumbar-multifidus-muscle-function-and-nociceptive-sensitivity-in-low-back-pain-patient-responders-versus-non-responders-after-dry-needling-treatment/#sthash.pKUQYJeG.dpuf

Not much is known about the physiologic mechanism of dry needling. Although some evidence suggests that dry needling may decrease nocioceptive sensitivity and facilitate muscle function, no studies to date have examined these physiologic changes compared to clinical outcomes. The objective of this study was to examine changes in lumbar multifidus (LM) muscle function and nociceptive sensitivity after dry needling in patients with LBP and to determine if such changes vary in patients that exhibit improved disability (responders) and those that do not (non-responders). Patient responders showed greater improvements in LM muscle contraction and nociceptive sensitivity 1 week, but not immediately, after dry needling than non-responders.
These results indicate that there may be lasting and clinically relevant sensorimotor changes that occur in LBP patients that improve with dry needling treatment that partially account for the physiologic mechanism of action.
- See more at: http://www.physiospot.com/research/changes-in-lumbar-multifidus-muscle-function-and-nociceptive-sensitivity-in-low-back-pain-patient-responders-versus-non-responders-after-dry-needling-treatment/#sthash.pKUQYJeG.dpuf

Not much is known about the physiologic mechanism of dry needling. Although some evidence suggests that dry needling may decrease nocioceptive sensitivity and facilitate muscle function, no studies to date have examined these physiologic changes compared to clinical outcomes. The objective of this study was to examine changes in lumbar multifidus (LM) muscle function and nociceptive sensitivity after dry needling in patients with LBP and to determine if such changes vary in patients that exhibit improved disability (responders) and those that do not (non-responders). Patient responders showed greater improvements in LM muscle contraction and nociceptive sensitivity 1 week, but not immediately, after dry needling than non-responders.
These results indicate that there may be lasting and clinically relevant sensorimotor changes that occur in LBP patients that improve with dry needling treatment that partially account for the physiologic mechanism of action.
- See more at: http://www.physiospot.com/research/changes-in-lumbar-multifidus-muscle-function-and-nociceptive-sensitivity-in-low-back-pain-patient-responders-versus-non-responders-after-dry-needling-treatment/#sthash.pKUQYJeG.dpuf

Topical Pain Relief: Creams, Gels, and Rubs

When your joints are painful or your muscles ache, topical pain killers -- those you apply to your skin -- may offer relief. You'll find many products for topical pain relief at your local drugstore.
Here are some popular options and what you need to know if you'd like to give them a try.

Analgesic Creams, Rubs, and Sprays

Topical pain killers, or analgesics, are sprayed on or rubbed into the skin over painful muscles or joints. Although are all designed to relieve pain, different products use different ingredients. Here are the most common ingredients found in products available without a prescription.

• Counterirritants. Ingredients such as menthol, methylsalicylate, and camphor are called counterirritants because they create a burning or cooling sensation that distracts your mind from the pain.
• Salicylates. These same ingredients that give aspirin its pain-relieving quality are found in some creams. When absorbed into the skin, they may help with pain, particularly in joints close to the skin, such as the fingers, knees, and elbows.
• Capsaicin. The main ingredient of hot chili peppers, capsaicin is also one of the most effective ingredients for topical pain relief. When first applied, capsaicin creams cause a warm tingling or burning sensation. This gets better over time. You may need to apply these creams for a few days up to a couple of weeks before you notice relief from pain.

Not everyone will have good pain relief from these preparations, and capsaicin in particular may not help with osteoarthritis pain.
Here's what you need to know to get the greatest effects and minimize the risks of these products:

• Read the package insert and follow directions carefully. If there is an insert, save it to refer to later.
• Never apply them to wounds or damaged skin.
• Do not use them along with a heating pad, because it could cause burns.
• Do not use under a tight bandage.
• Wash your hands well after using them. Avoid touching your eyes with the product on your hands.
• If you are allergic to aspirin or are taking blood thinners, check with your doctor before using topical medications that contain salicylates

Soothe Your Aching Back

	Soothe Your Aching Back
	Arthritis can affect your back and lead to daily stiffness and pain. Take a look at steps to ease the discomfort, sleep better, and feel your best.